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Greeks, Seeking Access to Health Care, Stuff Envelopes Full of Cash

In the land where Hippocrates was born, and the principle of selfless medicine invented, it has come to this: desperate Greek patients stuffing envelopes full of cash, in order to convince a doctor to see them. So reports Charles Forelle in today’s Wall Street Journal, where the end result of socialized medicine is on full display.

“Like nearly all Greeks,” writes Forelle, “[George] Gianakouras was covered by a state social-security fund, which paid €10,000 ($13,600) for [his] hospital bill. There was one more thing: Mr. Gianakouras said he gave his surgeon ‘black money’—€5,000 in cash—to perform the operation. ‘If you don’t pay,’ he said, ‘you don’t get anything done.’” It has gotten to the point where the hallways of Greek hospitals are plastered with those circular no-smoking signs, with the red slash through the middle, except that the lit cigarette has been replaced by a stuffed envelope.

This is the point in the story where you get to pat yourself on the shoulder. “That could never happen here,” you reassure yourself. “Greeks are dirty, corrupt people, unlike us.” Admit it—that’s what you’re thinking. And, it must be conceded, Greece ranks 78th out of 178 countries in Transparency International’s 2010 Corruption Perceptions Index, below Bulgaria and Romania.

But the Greek experience points to the central illusion of government-controlled medicine. Advocates for state-sponsored health insurance do so out of a passionate conviction that such systems make their societies more equal. But, in reality, state-run systems create a coercive form of inequality, in which the poor and the middle class are consigned to ghettoized, inferior health care, while the rich and the politically-connected get the best care in the world.

This is what happens in Canada, which ranks sixth-best in the corruption survey (the U.S. ranks 22nd). When the multimillionaire Conservative premier of Newfoundland, Danny Williams, needed heart surgery, he didn’t need to bribe a Canadian surgeon to jump over that country’s infamously interminable waiting lists. Instead, he hopped on a plane and headed to an “undisclosed location” in the United States. “It was never an option offered to him to have this procedure done in this province,” explained Kathy Dunderdale, Newfoundland’s Deputy Premier.

In western country after western country, when the budgets get tight, governments try to balance their budgets by underfunding doctors and hospitals. Eventually, these providers do the rational thing and shut their doors to all but those who will pay more. It isn’t about corruption—it’s about math.

In September, large pharmaceutical companies like Roche and Novo Nordisk were forced to stop delivering life-saving drugs to Greek state-funded hospitals, which have paid for only $970 million of the $2.62 billion in drugs they used from January 2010 to June 2011. (The Greek government did end up paying some of these bills using—you guessed it—Greek government bonds.) In today’s WSJ article, Forelle talks about the extensive black market that has emerged from Greece’s financial failures:

Public health care’s strained finances have created a large private system, widely used by wealthier Greeks, as well as a shadow system built heavily on bribes—the envelopes of cash known in Greece as fakelaki. Generally, €20 to €50 buys a fast, basic office visit; surgeries can be thousands of euros, according to figures from Transparency International, the anticorruption group, which rates Greece the European Union’s most corrupt country.

“The state has exchanged public funding for private, under-the-table payments,” said Lycourgos Liaropoulos, a professor at the University of Athens and a prominent health-care economist. A study by Mr. Liaropoulos and his colleagues found that Greeks spend nearly as much on bribes and other “informal” payments as they do on “formal” costs such as insurance co-pays.

Bribery is so endemic that visitors to Evaggelismos Hospital in the heart of Athens will spot peculiar stickers in a corridor leading to the surgical suite. They look from a distance like no-smoking signs. But in place of the lit cigarette crossed through with a red line, there’s a hand offering an envelope.

The system is plainly under strain. Petros Avgerinos, an internist at the Polyclinic Omonia, a public facility in central Athens, said the hospital recently went several months without needles for bone-marrow biopsies. Like many doctors and some policy makers, he suggests legalizing the forbidden payments to help finance hospitals. “Greeks don’t feel well if they don’t pay their surgeon. It’s like a dowry,” Dr. Avgerinos said.

“In every house where I come, I will enter only for the good of my patients,” says the famous oath attributed to Hippocrates. Government-run, fiscally-broke medicine has made that oath harder, not easier, to uphold.

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You use an example from a country rife with corruption to denigrate Canadian health care? I saw no facts in your article about the health and welfare of Greek citizens, nor any reference as to how ‘corrupt’ the Canadian system is. Even your example of the wealthy getting better care required them to go to the American system, as the Canadian wasn’t going to push people out of the way for this individual.

If your point is that the wealthy can buy better healthcare, I don’t think anyone is going to argue about that. It is a shame that so many of the wealthy are too stupid to see that they will get even better healthcare when everyone is covered. If a wealthy person has to shake hands or share an elevator with an uninsured person, they all run the same chance of getting a communicable and easily treatable illness. If all the people in the elevator got flu shots EVERYONE benefits.

In our (USA) healthcare system, clearly the wealthy can buy better individual service. Steve Jobs is presently not using a very expensive liver that might have been better put in someone other than a 54 year old male with terminal pancreatic cancer. In Canada and probably even Greece this would never happen.

You are quite correct in observing that wealthy have better access to health care than others, in Greece, Canada, and the United States. However in Greece and Canada people who are not wealthy can also get health care while the same cannot be said here in the United States. Your blog is excellent demonstration of why “Obamacare” is necessary.

And the same complaint is made again and again, that doctors don’t get paid enough by the governments of countries with universal health coverage, or from US medicaid/medicare, and this results (or will result) in their refusal to provide their services at the offer rates of reimbursement:

“In western country after western country, when the budgets get tight, governments try to balance their budgets by underfunding doctors and hospitals. Eventually, these providers do the rational thing and shut their doors to all but those who will pay more.”

Yet in another article, you suggest that Americans go abroad to get medical services in order to lower their medical costs and insurance premiums:

“Medical tourism is a promising approach to reducing health costs … Mexican physicians at far lower prices than are required in the U.S. Access to low-cost care could help bring down Texan insurance premiums, making health care more affordable.”

How much do US doctors make from an operation performed in Mexico? $0.

How much do French doctors make from an operation performed in Thailand? 0 Euro.

So what is the problem with governments paying doctors less than they would like when your proposed alternative is that they make nothing?

You argue that low pay will make North American and EU doctors close the doors to everyone but the wealthy. But with medical tourism, NA/EU doctors must cut their costs or go out of business entirely.

And who has the greatest ability to go abroad for health care? The wealthy people who you claim would be the only patients seen by NA/EU doctors.

So it would seem that NA/EU doctors would therefore be in competition with cheaper doctors in Latin America and Asia, and this competition would drive down their billing rates.

Which is what allegedly what they refuse to do when faced with lower pay within their national borders.

And the rational thing to do for Latin American and Asia doctors when they receive a stream of North Americans and Europeans coming to their countries for medical care would be increasing their prices to the maximum level at which it would still be beneficial for NA/EU citizens to continue to travel internationally for care.

Thus medical service prices would converge at the price where, for example, Mexican doctors charge as much as they can with consideration of travel costs. And US doctors would be forced to charge the Mexican rate + travel costs in order to retain business.

And citizens of Latin American and Asia countries would lose access to medical care due to price increases caused by the influx international patients.

And those international patients would have a serious problem dealing with malpractice across international boundaries. If you live in Forbes’s whipping boy of Massachusetts, do you really want to have to file a malpractice claim in Bangkok?

@daviddeLA: people who are poor in America get Medicaid, which is not the same thing as health care.

@jwpolichak: you seem to glide over the fundamental difference between those in other countries who voluntarily offer cheaper prices, due to lower costs, and those here who are forced to lose money because of government diktat.

You wrote:”people who are poor in America get Medicaid, which is not the same thing as health care.”

In my original posting I did not say anything about the “poor”. I simply said that in “Greece and Canada people who are not wealthy can also get health care while the same cannot be said here in the United States. ” There are millions of people in this country who do not qualify for Medicare or Medicaid but are uninsured and cannot access medical services.

Medical bankruptcy is no myth. the inflated prices charged by hospitals and some doctors are far out of bounds compared to the earnings of the average worker. To charge someone a month’s salary for 30 minutes of the doctor’s work is obscene to the point of extortion, holding a person ransom for their very life. The drugs in hospitals are marked up 1000 percent, price gouging with no basis in the cost of providing the material or service, just plain excessive profiteering off a person with no options but to pay or die. Such greed is inexcusable. I have checked the international price on one medication, and found it at $15 a month; the same medication is denied in generic form in the US, and priced at $265 a month. This is extortion made possible by exclusive right of sale agreements between government and private business, where citizens are forbidden to buy on the “free market” from the source of their choice. Legalized extortion is the reason why our health care is too costly for anyone but the most wealthy to pay for. Those who take advantage of this system, constantly talk falsely about socialized medicine, as in this article, hoping to convince people to abandon hope for a legitimate system of health care, but we are not blind or stupid, we can see the corruption and immoral greed that has ruined health care. Private insurance companies charge up to 1/3 for administration services that Medicare delivers for 4%. Private insurance is a parasite on health care that takes money away from health care while providing nothing in return. Prices must be limited, and socialized health care achieves that need. Greed based systems cannot be sustained, as the greedy are never satisfied.

“There are millions of people in this country who do not qualify for Medicare or Medicaid but are uninsured and cannot access medical services.”

1. Obamacare, which you support, expands insurance coverage in large part by putting 16 million more people on Medicaid, thereby consigning those people to terrible healthcare and poor access to medical services.

2. Just because someone is uninsured does not mean he does not have access to medical services. Many people who are uninsured can afford health insurance and choose to go without it (hence Obamacare’s individual mandate).

http://washingtonexaminer.com/node/154901

3. In addition, thanks to EMTALA, everyone has access to emergency care, regardless of insurance status. Hardly an optimal situation — but far different from what you portray.

You point out no failures in socialized medicine. The Greek system still offers excellent healthcare, even the source article never states otherwise. No one goes without. You may be implying that they could not offer healthcare to everyone if they have to impose austerity measures, but I would bet dollars to donuts (say an even dozen) that they will still have socialized medicine when they are done. Your example of the Canadian system failing is a very wealthy person coming to America for elective heart surgery? Isn’t that a success story? “We will use public resources in a manner that best serves everyone. If you wish to and can afford to use private providers, please do so.” It does not surprise me at all that wealthy people from other countries come to America to buy organs that their own healthcare systems would give to more deserving (but not rich) patients.

If you are implying that countries with socialized medicine will have to embrace our system you are fooling no one but yourself and your rich clients. Our system is known as a deadly embarrassment around the world.

The outcomes discussion we’ll have to take up later. But if you think the Greek system is a success, you are saying that a bankrupt country facing a massive currency devaluation and economic destruction is a “success.”

There’s no “voluntary” about it. Doctors in other countries have a lower standard of living, and less income, than NA or EU doctors, and are not interested in staying there. There’s no reason why a Mexican doctor wouldn’t charge the maximum that they could any more than a US doctor wouldn’t charge the maximum they could.

You seem to forget the fundamental economic principle that prices will converge on the maximum that the market will bear, after factoring in other costs, such as transportation.

Who volunteers to provide a cheaper price? No one. Those who provide a cheaper price do so to gain a competitive advantage. And it is to their advantage to make that price difference as small as possible while maintaining or improving their market position.